Reproductive freedom

Opting out on religious grounds

ARE your rights being violated when health-insurance plans are required to cover procedures you find objectionable due to your personal religious taboos? The Family Research Council thinks they are, writes the Washington Post (h/t Kevin Drum):

Virtually all health insurance plans could soon be required to offer female patients free coverage of prescription birth control, breast-pump rentals, counseling for domestic violence, and annual wellness exams and HIV tests as a result of recommendations released Tuesday by an independent advisory panel of health experts.

...Jeanne Monahan, director of the Center for Human Dignity at the socially conservative Family Research Council, said that many Americans may object to birth control on religious grounds. “They should not be forced to have to pay into insurance plans that violate their consciences. Their conscience rights should be protected,” she said.

You know what offends my conscience? Parents who discourage their children from using contraception or having abortions for religious reasons, and whose daughters wind up becoming teen mothers as a result. I don't want my insurance premiums subsidising that sort of behaviour. Those parents should be required to pay for their daughters' prenatal care and deliveries out-of-pocket, or to pay higher premiums to compensate for the increased risk of teen pregnancy they're forcing their daughters to run. The same goes for people who refuse vaccinations on religious grounds and who end up getting sick. I want an insurance plan that will not reimburse for fundamentalism-related conditions. In fact, to protect my "conscience rights", I think insurers should be required to offer every client an option that doesn't reimburse for fundamentalism-related conditions, with an actuarially accurate corresponding lower premium to guarantee that none of my insurance dollars are being used to pay for other people's superstitious health behaviour. I don't see why I should be paying for some born-again lady who refuses to let her sexually-active teenage daughters use the pill, running up hospital costs and wrecking her daughters' prospects for educational and economic advancement.

How's that for a little religious warfare? Obviously, I don't really believe any of those things. I'm willing to let my insurance premiums and Medicaid taxes cover prenatal care for teen mothers in born-again Christian families; it's not those girls' fault that they were born into that ideological milieu, and they and their babies should get decent health care regardless. This is just part of what it means to participate in a modern integrated society. Being part of America means having some level of tolerance for people's different preferences without constantly demanding to secede. Once you start down the road of demanding monetary exceptions for your private moral convictions, there's nowhere to stop.

The Family Research Council stance on birth control appears to represent approximately no American women. The Post article cites research by the Alan Guttmacher Institute finding that 98% of Catholic women and nearly 100% of evangelical women have used contraception at some point. On the merits of the recommendations, they're part of a National Academy of Sciences Institute of Medicine report commissioned by the Affordable Care Act: "Clinical Preventive Services for Women: Closing the Gaps". The authors write:

[T]he focus on preventive services is a profound shift from a reactive system that primarily responds to acute problems and urgent needs to one that helps foster optimal health and well-being. Women stand to benefit from this shift given their longer life expectancies, reproductive and gender-specific conditions, and historically greater burden of chronic disease and disability. And, for the same reasons, they will benefit economically since the ACA removes cost-sharing requirements for specified preventive services—eliminating out-of-pocket costs that often put screenings, counseling and procedures supporting health out of reach for moderate- and lower-income women.

...For sexually active women, the committee found that current recommendations of screening for cervical cancer, counseling for sexually transmitted infections, and HIV counseling and screening are too limited in scope and should be expanded. It also made several recommendations that support women's reproductive health. These include a fuller range of contraceptive education, counseling, methods, and services so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes. Additional recommendations address needs of pregnant women, including screening for gestational diabetes and lactation counseling and equipment to help women who choose to breastfeed do so successfully.

America has far and away the highest rates of teen pregnancy in the developed world. Research consistently indicates there are a lot of women out there, particularly low-income women, who want to have more control than they do over their reproductive timing. They don't want to be having babies. I don't want them to be having babies they don't want, particularly if I have to pay for those babies. Requiring insurers to cover birth control and counseling will lead to these women having more control over their reproductive choices. It means that, as everywhere in the world where women gain control over their reproductive choices, they will have more freedom. If, of all the things that might offend your conscience at this moment in world history, you pick this, then I submit you've got a weird conscience.

Can't think of anything to rebuke that? In that case insurance shouldn't cover anything related to obesity (people shouldn't eat so much), accidents (if you want intact ACLs you shouldn't play sports), or sickness (if you want to stay healthy, you should stay at home in a hermetically sealed bubble).

Or we could accept that people will have sex no matter what, and choose the option that's best for public health, personal freedom, and insurance costs.

So if you and M.S. have competing interests regarding insurance coverage, how about we settle it by the relative costs? Contraception is cheap, pregnancies are expensive, and unwanted pregnancies are very expensive.

Growing up in the Deep South, I heard that arguement all the time, and there's an easy way to rebuke it:

It doesn't work. Even if you think that people shouldn't have sex if they don't want to get pregnant, the fact of the matter is that they do (have sex, that is). Sexual desire is hardwired into most folks, and sometimes even the most devout unmarried Southern Baptist cannot overcome the temptation. People are "a he'n and a she'n" (by far my favorite euphimism for sex, btw, but I digress) out of wedlock all over the place, and the government can't really stop that, so easily-accessible birth control is infinitely more desirable than just issuing unenforcable, not to mention completely ineffective, moral decrees. Even if low-income/unmarried/immature/whoever they think shouldn't be having sex/children people can all easily get birth control, there's nothing stopping the evangelicals from encouraging people to leave enough room for the Holy Spirit in their dating life, so everyone wins!

Now if only there was an easy way to get people to understand the rebuke...

Yes, abstinence is more effective than contraception, if followed, in preventing unwanted pregnancies. But since abstinence, by definition, involves not having sex, it's a lot harder to follow than contraception if you want to have sex. Even people who say they don't want to have sex (abstinence pledgers, etc.) want to have sex - that's why they wind up having sex.

For these women having children before they want to, clearly the desire to have sex outweighed their desire to avoid an unwanted pregnancy, regardless of the religious beliefs of themselves or their parents. Contraception allows the stated goal of minimizing the risk of pregnancy to be pursued under the constraint of the overriding, unstated goal to have sex.

The main argument of the Confederacy was they had the right to treat other human beings as property, that interfering with this right - their property interest in people - infringed their liberty and made them little more than slaves. We see echoes of this, oddly since he's African-American, in Herman Cain's pronouncement that not being allowed to prevent American Muslims from opening a mosque infringes on his freedom; it is literally his right to oppress others.

For years, the religious fanatics have insisted they have a right to oppress us. They insist we give in to their beliefs. I say I want the right to oppress you back. If you claim the right to impose on me restrictions about abortion, mandates about prayer, idiocies about creationism, then I claim the right to oppress you in return.

"I don't want them to be having babies they don't want, particularly if I have to pay for those babies."

That is the beauty of their plan; you eliminate welfare as well, so you don't *have* to pay for their babies! Just look at the history of the world; any time government and society gave minimal or no support to the weakest members of society, those members always found a way to support themselves. Poverty was non-existent until FDR; these programs in no way came about because the problem was there beforehand.

Just look at Somalia. They have no government or welfare programs, and there aren't any starving babies or mothers over there, right?

@Canadian Guy
If you think that genetics plays a greater role in making people overeat than making them procreate, I suggest you go back to school.

There is nothing, NOTHING, more hardwired into every species which exists today than the sex drive. This is evolution at its most simple, if you don't have the drive to have sex, you die out in a single generation (unless you are capable of asexual reproduction, but I wouldn't reccommend it).

There's also a genetic predisposition towards pregnancy: as a man, I'm 100% safe from it. The point is that a behavior is a risk factor. You can't become obese unless you consume many more calories than you use. You can't dislocate your shoulder on a tackle if you don't play football, and you can't catch the flu from a kid in your class if you're homeschooled.

The more I think about it, the more I think that obesity is a good parallel to pregnancy. You can't prevent either by just telling people not to eat or have sex. We're incredibly lucky to have a cheap pill (or patch or whatever your choice is) that is 99% effective at preventing unwanted pregnancies. If we had the same thing in regards to obesity, we shouldn't let moral outrage about gluttony prevent the improvement in public health.

Once you start down the road of demanding monetary exceptions for your private moral convictions, there's nowhere to stop.

Once you start down the road of demanding money for private moral convictions, there's nowhere to stop. Of course, in both cases, we stop where we believe the common good is best served. We can debate where that line should be drawn but that's precisely what the business of governing is all about.

The Post article cites research by the Alan Guttmacher Institute finding that 98% of Catholic women and nearly 100% of evangelical women have used contraception at some point.

The research arm of Planned Parenthood said that? Then it must be unbiased truth. Even if it were, here outside the socialist world, there's a difference between buying contraception and subsidizing contraception.

War against religion eh? Mmmmm. Not sure about your chances. I hope Fox and Friends don't find \ your blog otherwise Gretchen will put you up for mass ridicule.

If this religious fundamentalism thing boils your blood it would be easier to move to Europe. 85% of Swedish and 44% of British are atheist apparently, and the rest pretty much only go to church for weddings. Or try Australia, Russia or China. You might find the atmosphere more pragmatic and tolerant. But then, it depends whether you want to let the fundamentalists take over the nation. Alternatively, can the US make certain states secede? Say the ones in the middle.

I always thought insurance was a tool to cover unexpected and unpredictable expenses. I'm a little bothered by the notion of insurance as a sort of admissions fee to a smorgasbord of medical care.

Who wants to bet that in the next two years there will be a new form of birth control that is a marginal (or no) improvement over others, but is 10x the price, all covered by your insurance.... And then let's talk about the spiraling cost of health-care.

Sorry, my phrasing was poor. I agree with you on cost not being able to decide broad issues. I'm positing cost as a deciding factor once we're within the realm of publicly available health insurance. In that case you've got a moral imperative to provide contraception butting up against a moral imperative not to, so I see it as reasonable to look to cost as decider when there's no clear majority choice.